Early Diagnosis and Intervention of Acute Renal Infarction with Catheter-Directed Thrombolytic Therapy.

Background: Acute renal infarction is a rare and under-diagnosed disease for which the optimal treatment is unknown. Objectives: This study aimed to determine the utility of catheter-directed thrombolysis (CDT) to treat acute renal infarction. Methods: From November 2010 to September 2017, 13 patients with acute renal infarction were treated with CDT. The diagnosis was confirmed by contrast-enhanced computed tomography and renal angiography. Results: The most common symptoms and signs were flank pain (53.8%) and abdominal pain (30.8%). More than two-thirds of the patients (69.2%) had atrial fibrillation. In successful reperfusion cases, the median time from symptom onset to diagnosis was 6 hours, and the average time from diagnosis to treatment was 3.5 hours. Complete resolution of thrombi in the renal artery was achieved in 10 of the 13 patients (76.9%) and partial resolution in two patients (15.4%). Only one patient (7.7%) failed to respond to treatment. Compared with admission, renal function was significantly improved at 6 months. No major complications occurred during the course of CDT therapy. Conclusions: CDT offers an alternative to surgical intervention and can achieve good angiographic results with an early diagnosis and intervention. It is relatively safe and can restore at least partial renal function.

The Clinical Application of the Tracheostomy Decision-Making Program in Respiratory Care Center Prolonged Mechanical Ventilation Patients in Taiwan.

BACKGROUND: We applied the tracheostomy decision-making program for respiratory care center prolonged mechanical ventilation patients. Our objectives are to correct the misconception of patients about tracheostomy. We expect to understand whether the program is effective in educating patients and whether the patients are satisfied with the results of their decision-making. We compared the prognostic differences between patients receiving tracheostomy and those who continue to have an endotracheal tube, which serves as our basis to provide suggestions for patients in the shared decision-making program. PATIENTS AND METHODS: A retrospective study was conducted in Dalin Tzu Chi Hospital from January 2017 to December 2019. We set up a tracheostomy decision-making program. The medical team identified eligible patients. We tracked the survival of each patient and followed up on each patient to ask whether they thought they had made an optimal decision based on the results of their participation in the tracheostomy decision-making program in January 2020. Data of respiratory care center prolonged mechanical ventilation patients who participated in the tracheostomy decision-making program were collected and analyzed. RESULTS: Fifty-seven respiratory care center patients attended the tracheostomy decision-making program. At the end of the study, 37 patients underwent tracheostomy (64.9%), and 20 patients maintained endotracheal tube intubation (35.1%). The survival rate of patients undergoing tracheostomy was 86.5% and 32 participants (86.5%) believed that they made an optimal decision after participating in the tracheostomy decision-making program. The survival rate of patients who maintained endotracheal tube intubation was 40%, and twenty (100%) participants believed that they made an optimal decision after participating in the tracheostomy decision-making program. CONCLUSION: The clinical application of the tracheostomy decision-making program ensures that patients have a clearer understanding of the methods of tracheostomy and endotracheal tube intubation. Overall, 91.2% of the participants believed that they made an optimal decision despite the end result.

CHA2DS2-VASc scores predict major adverse cardiovascular events in patients with chronic obstructive pulmonary disease.

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) frequently experience concurrent comorbidities; therefore, risk assessment for major adverse cardiovascular events (MACEs) is very important. OBJECTIVES: We explored the association between COPD and risk of MACEs with three common clinical events: acute myocardial infarction (AMI), ischemic stroke (IS), and cardiovascular death (CVD). METHODS: We evaluated the predictive value of the CHA2DS2-VASc score (congestive heart failure [C], hypertension [H], age [A], diabetes [D], stroke [S], and vascular disease [VASc]) for MACEs in COPD patients. In this observational study, we retrospectively reviewed the records of 29 258 patients with COPD between 2005 and 2009 in relation to MACE risk using the CHA2DS2-VASc score. We calculated the hazard ratios (HR) and 95% confidence intervals (CI) using a significance level of .05. RESULTS: Patients with COPD had significantly (P < .001) increased risk of MACEs, and a high prevalence of CHA2DS2-VASc scores ≥ 6, predicting MACEs (16.1%), AMI (3.3%), IS (8.7%), and CVD (4.0%). A good discrimination was found for MACEs, IS events, and CVD events (AUC = 0.740, 0.739, and 0.778, respectively) but poorer discrimination for AMI events (AUC = 0.697). CONCLUSION: Early lifestyle modifications and antithrombotic therapy may be essential for COPD patients at a high risk of MACEs, that is, those with CHA2DS2-VASc scores ≥ 6.

The effect of enterohemorrhagic E. coli infection on the cell mechanics of host cells.

Enterohaemorrhagic E. coli (EHEC) is a type of human pathogenic bacteria. The main virulence characteristics of EHEC include the formation of attaching and effacing lesions (A/E lesions) and the production of one or more Shiga-like toxins, which may induce human uremic complications. When EHEC infects host cells, it releases translocated intimin receptor (Tir) and effector proteins inside the host cells, inducing the rearrangement and accumulation of the F-actin cytoskeleton, a phenotype leading to the formation of pedestals in the apical cell surface, and the growth of stress fibers at the base of the cells. To examine the effect of EHEC infection on cell mechanics, we carried out a series of experiments to examine HeLa cells with and without EHEC infection to quantify the changes in (1) focal adhesion area, visualized by anti-vinculin staining; (2) the distribution and orientation of stress fibers; and (3) the intracellular viscoelasticity, via directional video particle tracking microrheology. Our results indicated that in EHEC-infected HeLa cells, the focal adhesion area increased and the actin stress fibers became thicker and more aligned. The cytoskeletal reorganization induced by EHEC infection mediated a dramatic increase in the cytoplasmic elastic shear modulus of the infected cells, and a transition in the viscoelastic behavior of the cells from viscous-like to elastic-like. These changes in mechanobiological characteristics might modulate the attachments between EHEC and the host cell to withstand exfoliation, and between the host cell and the extracellular matrix, and might also alter epithelial integrity.